The capacity to unite biological tissues and/or to protect these unions (i.e., “anastomosis”) has been an area of very important research for the biomedical investigators for several decades.
One of the greater problems that plague patients and surgeons world-wide is proper healing of an anastomosis within the gastrointestinal system and those of other systems as well. Dehiscence or faulty healing of the anastomosis may occur even though the anastomosis is well indicated, in the appropriate patient, and is adequately performed. Some dehiscences carry a high mortality rate (30-50%) and their complications require urgent reoperations and prolonged hospitalization in the intensive therapy units involving, for example, parenteral nutrition, complicated respiratory care, prolonged and costly antibiotic-therapy, numerous laboratory tests, etc.
At the present time, obesity has reached epidemic proportions throughout in the world, in developed as well as in underdeveloped countries. For example, in the United States of America one of every three adults is obese and approximately 5% suffer from morbid obesity, i.e., a body mass index (BMI) of 35 kg/m2 or greater, and, what is worse, 1 of each 6 children suffers from obesity1,2. Although numerous medical treatments exist, these treatments only aid those patients with lower degrees of obesity, or in the short term, patients with morbid obesity, since, although initially the patients loose weight, a follow-up 10 to 15 years after the treatment demonstrates that 98% of the patients have returned to their initial levels of obesity (“bounce”). Thus, they remain obese and frustrated.1-4 Morbid obesity is recognized at the present time as a chronic, incurable multi-factorial disease, the effects of which damage several organ systems that not only decrease the duration of life, but also the quality of life as well. Obesity affects the organism through the so-called co-morbidities, the most important ones being diabetes mellitus II, arterial hypertension, ischemic accidents of the heart and the cerebral circulation, serious pulmonary complications such as sleep-apnea, pulmonary disease of the obese, thromboembolic accidents, gastroesophageal reflux, several osteo-articular disorders, alterations of fertility, urinary incontinence, dislipidemias, etc1-6. Moreover, objective evidence exists that obesity is a predisponent factor for the development of several malignant tumors such as breast cancer, colon-rectal cancer, prostate cancer, endometrial cancer, myelomas, leukemias, etc.1-4 
Since the world-wide consensus meeting of 1991 in the United States of America, at the National Institutes of Health (NIH), 4it has been concluded that surgery is the only effective method for the control of the complications of obesity. With the introduction of the laparoscopic surgery everywhere in the world, the number of procedures of Bariatric surgery has increased in exponential form. But, due to economic reasons in some regions of the world, it is still practiced in conventional or open technique, which is also appropriate.1-6 
The two main causes of mortality, major complications and enormous costs of gastric bypass, bilio-pancreatic diversions, etc., are the improper healing of the anastomosis called dehiscence (a premature bursting open or splitting along a surgical suture line, like in the junction or connection between the ends of the intestine, or the stomach pouch and the intestine as in the gastric bypass) and pulmonary thromboembolism5-8. The prevalence of the first varies from 1 to 5% in general, it being less in some groups with more experience5-13. The mortality caused by the anastomotic dehiscence ranges from 30 to 50%. Serious peritonitis ensues in patients that are already complicated with pulmonary, circulatory problems, etc., and require immediate and urgent reoperations, as well as special treatment in an intensive care unit, as mentioned before, which is extremely expensive. The cost for the patients who survive is approximately $ 100,000 USD12. If 200,000 annual procedures are practiced in the USA, and if the prevalence of leaks is 2% (that at general level is greater), this would mean that the cost of these complications would be more than 20 million dollars annually, without taking into account indirect costs of the family, medico-legal and others.
This feared anastomotic dehiscence also occurs in surgery of the colon and rectum. The complications of diverticular disease are more and more frequent in patients older than 50 years (considering that life expectancy continues to increase everywhere in the world), like ischemic accidents, malignant tumors, volvulus, etc. The prevalence of dehiscences in anastomosis of the colon and rectum is greater than in Bariatric surgery and ranges from 5 to 15% of the cases reported in general. Also, mortality in these patients is greater, and the expenses in the intensive care unit are also very high for obvious reasons14-21. Colonic dehiscences, in addition, diminish survival rates for patients operated on for cancer22. When these patients are operated in elective or emergency situations, it is necessary to extirpate a segment of intestine. In debilitated, older patients, frequently with peritonitis, it is not possible to practice a primary anastomosis, but instead it is necessary to perform a colostomy or ileostomy. Colostomies save many lives but nobody likes them. They require special care in all patients, and almost all patients want to be re-operated on so that the intestine can be re-connected and they can live normally. But, that also means another surgery, additional risks, expenses, etc.
Because endoscopic surgery is already accepted internationally as adequate for colon cancer treatment16,21, as for well as non-malignant diseases17-20, the number of these procedures performed will increase, as happened with cholecystectomy, antireflux surgery, nephrectomy for renal donor and many other procedures.
In the esophagus, the situation is more serious than in the colon, since the organ does not have a serous layer and anastomotic leaks (for example, in resections for tumors, congenital diseases, caustic burns, antireflux reoperations, etc.) produce mediastinitis with very high mortality rates.23-25 
It was mentioned previously that anastomosis can present dehiscences in spite of being well indicated, well done manually, with staples or using a mixed technique, without tension, with good blood supply, with good nutritional status, without peritonitis, regardless of being elective or urgent. It is very important to mention that dehiscences appear between the second and tenth postoperative day, but 98% occur between the second and sixth post operative day.26,27 
During the 2nd thru the 8th postoperative day, the anastomosis does not have any strength by itself. In this time period, collagen deposition and new tissue bridges have not yet been built across the two ends (2nd phase of healing process). As a result, the anastomosis is very weak, inflamed due to the presence of sutures and staples (foreign bodies) and bacteria, clots, etc. It is precisely during this time period that anastomosis leaks (or failures) often occur with the ensuing very grave and often lethal complications.
Anastomotic dehiscences, like a perforated duodenal ulcer, initially produce a discharge of gastrointestinal secretions that cause an intense, localized inflammatory reaction called “chemical peritonitis.” Later on, the discharge process continues and more secretions and bacteria are discharged producing secondary peritonitis, a most feared cause of mortality.27-29 
In the case of peritonitis by perforation and/or dehiscence of the colon, the peritonitis is of fecal type from the beginning and therefore of greater gravity in patients that, e.g., due to their age, other cardio-pulmonary ailments, metabolic complications, malnourishment, etc., have a greater surgical risk from the outset.17-20 
In the esophagus, something similar happens with the discharge of diverse pathogenic germs in the mediastinum. Some groups such as Schardey et al. of Germany, affirm, based on their experimental and clinical observations, that “ . . . it can be prevented that the potentially pathogenic germs associated with the micro-leaks are in contact . . . and produce these dehiscences.” by means of the use of intensive antibiotic therapy.23,24 
A person knowledgeable in the area knows that in mammals in the healing process there are 3 main phases. The first phase starts immediately following the traumatic event with clotting accompanied by acute inflammation and, only after 7-8 days, the collagen deposition or second phase begins. The resultant scar is remodeled in the 3rd phase and then, there is considerable strength in this area weeks later. In the intestinal anastomotic area there is acute inflammation, clots, bacteria and secretions and it is known that during these days there is no collagen deposition in the edges. For this reason, the segments of intestine are held only by the sutures and/or staples, without bridges of new tissue to join both ends, but the anastomosis itself does not have any intrinsic firmness or strength per se. It is precisely in this critical period that most anastomotic failures or dehiscences occur. (Wasserberg N, Tzakis A G, Santiago S F, Ruiz Ph, Salgar Sh K., Anastomotic healing in small bowel transplantation model in the rat, World J Surg 2004; 28:69-73.). The method and adhesive herein described provide protection of the anastomosis during these critical days to prevent a dehiscence or failure to heal adequately.
In the case of fistulas that can be a consequence of an anastomotic dehiscence or trans-operative trauma, etc., they represent a very serious and annoying complication of various surgical procedures and some diseases of diverse organ systems like the gastrointestinal, respiratory, urinary, etc. When fistulas are not accompanied by obstruction or complicated with active suppuration, one can try to obliterate them with different methods or sealants with variable results30-33.
In inguinal, incisional and other parietals hernias, the “gold standard” surgical treatment nowadays is called “without-tension” wherein a prosthesis or mesh is placed in the defect.34-37. Fixation of this prosthesis can be performed in several ways to avoid its displacement, both in open or laparoscopic surgery, frequently using sutures or staples. Staples are very expensive and, like sutures, they can incorporate, catch or compress small nerves, or produce osteo-condritis and post operative pain. Post operative neuritis is one of the frequent and important complications in inguinal hernia operations and, unfortunately, a frequent cause of reoperations and legal actions. The effect of fixation in this case is also temporary since after 4 to 5 days the prosthesis is included by the local connective tissue and no longer will be displaced37. A brief inspection in the surgical congresses and current literature shows that great interest exists to find an effective and safe method of affixing prosthesis in these situations. In fact, novel methods and alternatives are continuously described.38,39 
U.S. Pat. No. 6,046,178 discloses a “wound treating” composition comprising a starch hydrosylate, such as maltodextrin, for treating open wounds or gaps in the skin tissue as in the treatment of burns, ulcers, lesions, and other skin defects. The starch hydroxylate is combined with sterile water and a gelatinization agent such as glycerin to form an emulsion. The starch hydroxylate mixes with the proteins in the wound fluid and forms a film that ultimately adheres to underlying tissue. The formed film is semi-permeable to air and fluid. U.S. Pat. No. 6,046,178 does not teach or suggest an adhesive or glue to be used in surgical practice for temporarily reinforcing and protecting the anastomosis of the digestive system (and of other organ systems), nor occluding fistulas nor affixing prosthesis in inguinal hernioplasties.
U.S. Pat. No. 5,985,312 describes using metal compounds such as zinc oxide to enhance the bioadhesiveness of polymers used in drug delivery devices such as microspheres, tablets, capsules, which contain a drug or a diagnostic agent. U.S. Pat. No. 5,985,312 does not suggest a bioadhesive polymer such as polysaccharide for use in surgical practice for temporarily reinforcing and protecting the anastomosis of the digestive system (and of other organ systems).
U.S. Pat. No. 4,600,574 disclose a tissue adhesive in which a tissue-compatible material such as polysaccharide is combined with a solution comprising fibrinogen and Factor XIII. Due to the presence of fibrin, this adhesive suffers from the disadvantages as discussed further below.
U.S. Pat. No. 5,496,872 disclose a non-toxic, biodegradable adhesive composition for surgical use. The composition contains a compound having at least two relative functions which can be used in combination with a biodegradable, synthetic or natural polypeptides such as polysaccharides.